Getting Started with CAD/CAM Dentistry

Dentists who have yet to make the leap to computer-aided design/computer-aided manufacturing (CAD/CAM) dentistry often have questions about how to be most productive with this new technology. With the right workflows and scheduling, you can be highly productive, increase profitability and keep your patients happier.

One major benefit of CAD/CAM is the ability to offer same-day restorations by scanning, designing and milling in-house. Patients appreciate this, because they don’t have to deal with temporaries or come back multiple times. And it makes for a happier dentist, too, because you can make the best use of your time.

Gaining workflow efficiencies

A CAD/CAM workflow offers many time efficiencies. The biggest time savings is how quickly you can prepare the tooth. Mastering scanning does take some time. It doesn’t happen overnight to learn this skill, but practice makes perfect. Creating a model and practicing prepping the tooth on the model is one way to help increase your speed and proficiency.

Taking an impression and then designing and milling it can be done in a matter of minutes. “Once you understand the design principles, there are no limitations to what you can do with it,” says Dr. Casey Bennett, a dental practitioner located in Summerville, South Carolina. “It's extremely accurate, so you basically don't need to make any adjustments. The restorations just fit. You can't even feel the interface between the restoration and the tooth most of the time.”

Practitioners usually schedule two hours for typical cases and three hours for more complicated cases. As an example of time savings, a posterior restoration takes roughly eight minutes for a premolar and 15 minutes for larger molars. If you schedule appropriately, you can work on other patients while the restoration is milling. Anterior restorations should take about 22 minutes, enabling you to still have a two-hour appointment with an anterior crown. From there, the next steps are to glaze, fire, deliver the restoration, clean it up and then take a final radiograph to ensure everything looks good.

You can have very productive days with this approach. For example, a patient comes in at 8 a.m. for their same-day crown. You get them numb, then move into a hygiene exam. Then you can get the tooth prepped, scanned and sent to the mill before the limited exam comes in. Timing wise, you have more fluidity. While it’s milling or any other downtime, you can see a limited exam, and then go and finish the crown.

For a crown procedure, it is critical that you not be scheduled anywhere else for the first 45 minutes. This gives you time to prepare the tooth, scan it and send it to the mill.

“With this type of schedule, we can bring in $6,341 gross production from CAD/CAM, and $1,538 gross production from other cases,” says Dr. Bennett. “Not every day will be like this, but if you can train your front desk to schedule appropriately, these days will become more frequent.”

In his Summerville office, Dr. Bennett has two doctors averaging 26 to 30 cases a month. “When we took into account the cost of the CAD/CAM equipment and considered the impression material, temporary material and lab costs, we found that the system paid for itself in one year,” explains Dr. Bennett. “One added financial advantage of taking digital impressions is decreased lab costs, since many labs are digitizing all impressions and will charge a lower digital rate than their conventional rate.”

Improving precision

Adopting CAD/CAM technology not only increases productivity and saves money but also improves the accuracy of restorations. With the traditional way of performing single-unit restorations, they were taken with a triple tray. Those can have a large discrepancy, depending on how rigid the impression tray is. The very flexible ones can introduce many distortions, resulting in a 50- to 210-micron discrepancy.

Impression accuracy is impressive and greatly improved with CAD/CAM. In the past, there were concerns that scanners might not be able to scan all substrates. However, researchers at the Medical University of South Carolina, James B. Edwards College of Dental Medicine, showed that the new generation of scanners are remarkably accurate on all substrates, including gold, zirconium, amalgam, enamel, dentin, blue core buildup and white core buildup, for complete arch scanning. Another study found high accuracy for cross arches.

Enhancing patient comfort

Digital impressions are also beneficial for patients because they are so much more comfortable. “When we start scanning, patients are so pleasantly surprised when it’s over,” says Dr. Bennett. “They ask, ‘Where’s the goop?’ It’s a better experience for them without having to deal with impression material.”

Patients no longer have to worry about dealing with temporaries — and you no longer have to go in after-hours to deal with temporaries that fell off.

Gaining a better bond

One of the advantages of CAD/CAM is how conservative you can be with how you prepare teeth. Once it’s lost, patients will never get back the enamel that they worked really hard to make. Using CAD/CAM dentistry lets you take away only the damaged portion of the tooth and replace that. There’s no need to take the finish line all the way down to the gum line. You can make really esthetic restorations while preserving a lot of that enamel.

With a conservative preparation design, there is a good deal of enamel to bond to, so the restoration will be very well locked down. Once the crown is delivered, it’s hard to see where the tooth ends and the restoration begins. These types of restorations are easy to clean too. When the patient brushes their teeth, they’re brushing right at that interface.

Optimizing CAD/CAM equipment performance

To ensure your new technology continues to offer maximum efficiency and accuracy, maintenance is needed. This includes:

• Changing the water (daily, depending on how many restorations you’re performing). Keeping the system lubricated is very important.

• Cleaning the cap weekly. It can have ceramic material buildup if you are performing a lot of IPS e.max®

• Cleaning the collet (the part of the milling unit that holds the burrs) If debris accumulates there, the burr won't seat completely, and that results in over or under-milling.

• Annual maintenance. A Henry Schein technician can verify that the system is clean, make any pressure or fluid adjustments and calibrate the system if needed.

For added convenience, it’s best to choose a system that automates, telling you things like when to change the fluid and when to change the burrs.

Conclusion

Traditional impressions may soon be left in the past, with more dentists moving to digital scans of patients' teeth. When it comes to the advantages of CAD/CAM, preventing the discomfort of physical impressions is just the start. This popular technology improves the practice image, as well as patient satisfaction. Adopting CAD/CAM dentistry makes sense, not only financially but from a clinical perspective, leading to improved precision and esthetics. And from a patient and provider perspective, there are tremendous gains in terms of convenience. Practices across the country are using CAD/CAM to expand into new indications, increase referrals and grow their business.

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